Out-of-pocket Cost of Neurosurgical Bellwether Procedures: A Systematic Review

Abstract

Introduction 33 million people worldwide face catastrophic health expenditures each year from surgery and anesthesia. This study aims to collate the current literature on out-of-pocket (OOP) costs of Bellwether neurosurgical procedures in low- and middle-income countries (LMICs) to provide a basis for calculations of financial burdens, determine deficits in the literature, and guide further research efforts. Methods MEDLINE/PubMed, Embase, Cochrane Library, Google Scholar and Relief Web were searched for articles containing data on OOP costs for neurosurgical Bellwether procedures in LMICs. Of 415 relevant publications that were identified, 4 met inclusion criteria. Results One study from Uganda found median direct medical and non-medical costs to be USD 118.06 and USD 84.33, respectively. A study from Vietnam found the total medical care and surgery for head injury OOP cost to be USD 287.30 and USD 63, respectively. A multi-country study found the cost of neuroimaging to vary by country income level and public/private institutions with a range of USD 14 to USD 286. Discussion There is great variability in OOP expenses for neurosurgical Bellwether procedures, but the average cost to the patient did not exceed USD 300. When assessing patient expenditures, attention should be given to average country income, as the cost of a medical expense may be lower in an LMIC but the impact on the patient greater due to lower income. More studies on OOP costs for neurosurgical interventions in LMICs are needed to provide evidence for policy changes geared towards financial risk protection.